Provider Demographics
NPI:1427012285
Name:HOMAN, CRAIG A (PA-C)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:HOMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 EASTSIDE RD
Mailing Address - Street 2:STE 110
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-9800
Mailing Address - Country:US
Mailing Address - Phone:608-348-4330
Mailing Address - Fax:608-342-4801
Practice Address - Street 1:1450 EASTSIDE RD
Practice Address - Street 2:STE 110
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-9800
Practice Address - Country:US
Practice Address - Phone:608-348-4330
Practice Address - Fax:608-342-4801
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI281-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1705OtherDEAN HEALTH INSURANCE
WI42904500Medicaid
WI1020737OtherPHYSICIANS PLUS
WI008857155Medicare PIN
WI1020737OtherPHYSICIANS PLUS
WI42904500Medicaid